Alpenrose Dinner-Dance Reservation Form
Weihnachtstanz Valencia Ballroom
December 11, 2011Doors open at 2:00 PM Dinner at 2:30 PM Dancing 4:00 PM. to 8:00 PM.
I plan to attend the dinner-dance with _______ Members @ $32.00 each, Total________
_______ Guests @ $36.00 each Total________
Grand Total________
Name_____________________________________ Telephone ( )_______________
Address____________________________ City/State________________ Zip________
Talk it over with whom you want to sit, ( It would be a great help) than let us know who is on your table, (tables of eight)
1-------------------------------- 2------------------------------------ 3------------------------------------4-------------------------------------5____________________6_______________________7__________________8_______________________
Return by no later than November 27, 2011. Please no exceptions. Please no refunds after Deadline. Make checks payable to (Alpenrose ) and mail to
Al Langis 12 Culpepper Rd. Shrewsbury, PA. 17361. No Tickets are issued for this event.
_______________
Separate here and pay separately_________________________________ Alpenrose Membership Renewal FormPlease renew ( my ) ( our ) membership to the German-American Society ( Alpenrose ) for 2012. Adult dues are $15.00 per year. Youth dues for 6 year olds through college are $7.50. The Deadline is March 31, 2012.
Please complete the information requested below.
Name: 1._________________________________________Name 2______________________________________
Street______________________________________________________________________________________
City:________________________State:__________________________Zip:_________________Telephone ( )________________
Send completed form and check payable to ( Alpenrose ) and a self-addressed, stamped envelope to [ Al. Langis 12 Culpepper Rd. Shrewsbury, Pa. 17361 ]
Date rec’d_____________________________ 2011 Card no. ___________________
Optional: Birthday 1.___________________ Anniversary:_______________________
Birthday 2. __________________ E-Mail:______________________________